Provider Demographics
NPI:1124262837
Name:SEAGLER, TRENT RANDOLPH (PT)
Entity type:Individual
Prefix:MR
First Name:TRENT
Middle Name:RANDOLPH
Last Name:SEAGLER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:DUMAS
Mailing Address - State:TX
Mailing Address - Zip Code:79029-3219
Mailing Address - Country:US
Mailing Address - Phone:806-934-2634
Mailing Address - Fax:806-934-2636
Practice Address - Street 1:515 E 1ST ST
Practice Address - Street 2:
Practice Address - City:DUMAS
Practice Address - State:TX
Practice Address - Zip Code:79029-3219
Practice Address - Country:US
Practice Address - Phone:806-934-2634
Practice Address - Fax:806-934-2636
Is Sole Proprietor?:No
Enumeration Date:2009-04-24
Last Update Date:2009-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1133346225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist